PVN Customer Information Sheet

PVN Customer Information Sheet
Date

MonthDayYear
Date
Company Name
Company Phone Number

Area CodePhone Number
Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Federal Tax ID Number
Authorized buyer

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Accounts Payable Contact

First NameLast Name
Accounts Payable Phone Number

Area CodePhone Number
Accounts Payable Email
example@example.com
Preferred method to receive invoices:
Should we charge you sales tax?
Sales Tax Exemption Number (if none, type N/A)
Include state of issue.
*Dealer or Grower's License Number
Include state of issue.
*A dealer's or grower's license number is required by the Nebraska Department of Agriculture if you intend to resell/redistribute nursery stock. If you intend to resell or redistribute and do not have a Dealer’s/Grower’s License, we cannot sell to you! To obtain a Nebraska license, contact Julie VanMeter at the NDA at 402-471-2394.
Payment is required upon receipt of plant material until a credit application has been completed and approved. We accept Visa, MasterCard, American Express, and Discover Card. All past due accounts are subject to a 1.5% finance charge per month. Please see page 2 of our catalog for an explanation of our discount program. We look forward to doing business with you!
Please send me email updates from Papio Valley Nursery.
Weekly/Biweekly during the busy season. Less often in off-season.
Should be Empty: